急性心肌缺血早期碱性成纤维细胞生长因子的免疫组化研究

采用免疫组织化学方法，对大鼠急性心肌缺血早期不同时间心脏不同区域碱性成纤维细胞生长因子basicFibroblastGrowthFactor：bFGF）的变化进行了研究。结果发现心肌缺血30min心肌局部即可出现bFGF阳性表达，并且随着缺血时间的延长其阳性表达的强度也有所增加。图像分析处理结果表明，缺血3h其表达水平达到高峰（55.26±14．75），明显高于对照组（7．27±2．49），而与缺血边缘区域（53．08±14．26）和正常区域(53．79±15．71）相当。3h后，心肌缺血区域bFGF的表达开始出现下降趋势，而缺血边缘区域和正常区域则开始呈现上升趋势。可为心肌缺血的早期诊断提供客观的形态学依据。     

冠状动脉急性病变斑块内Toll样受体-4表达的研究

目的探讨Toll样受体4（TLR4）与冠状动脉粥样硬化（AS）斑块急性病变的关系。方法从本教研室2004～2007年尸检档案中挑选24例病例及其心脏标本。分为实验组（有冠脉急性病变的SCD者）、对照组Ⅰ（无冠脉急性病变的SCD者）和对照组Ⅱ（冠脉无严重AS的暴力死者）等3组，每组8例。用免疫组化SABC法和图像分析技术定量检测TLR4在各组冠状动脉AS斑块内表达的平均光密度值（OD），所得数据用SPSS14．0统计学软件进行分析处理并比较各组间的差异。结果实验组冠状动脉AS斑块中TLR4表达呈强阳性，对照组Ⅰ呈相对较弱的阳性表达，而对照组Ⅱ冠状动脉壁及轻度增厚的内膜处均未见阳性表达，其OD值（0．4662±0．0190）与两个对照组（分别为0．3361±0．0165，0．2463±0．0190）相比，对照组Ⅰ与对照组Ⅱ相比，其差异均具有统计学意义（P〈0．01）。结论冠状动脉AS斑块中TLR4的表达情况可视作为冠状动脉AS斑块发生急性病变的一个病理诊断指标，也是诊断冠心病猝死的重要依据之一。     

Postmortem Serum Tryptase Levels with Special Regard to Acute Cardiac Deaths

An elevated serum tryptase concentration is considered a specific marker for systemic mast cell activation, a central feature of anaphylaxis. However, in some cases of acute cardiovascular death, high concentrations of serum tryptase are also observed. We compared the postmortem serum tryptase concentrations in 74 cases assigned to the following four groups: anaphylactic deaths (Group A, n = 20), acute cardiac deaths (Group ACD, n = 30), acute dissecting aneurysm ruptures (Group ADA, n = 10), and controls (Group C, n = 14). Additionally, the cutoff between Group A and the other groups was calculated using receiver‐operating characteristic (ROC) curve analysis. Tryptase concentrations were markedly elevated in Group A (p < 0.001), Group ACD (p = 0.015), and Group ADA (p = 0.005). The optimal cutoff was 43 ng/mL, the sensitivity was 90%, and the specificity was 98%. While elevated concentrations of tryptase were noted in practical autopsy cases, due attention should be paid to the differential diagnosis between anaphylactic and acute cardiovascular deaths.     

Sickle Cell Trait Mimicking Multiple Inflicted Injuries in a 5-Year-Old Boy

Abstract:  Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can occur and are classically limited to bone infarcts. The occurrence of bone pathology centered upon the epiphyseal growth plate in SCD/SCT is extremely rare, and multiple such injuries in a single patient have not been previously reported. Herein, we describe a case of sudden unexpected death in a 5-year-old child with undiagnosed SCT due to the ACS, with widespread epiphyseal and periosteal bone lesions mimicking multiple inflicted injuries at autopsy. This case highlights the importance of clinicopathological correlation and is the first to describe SCT pathology as a mimic of nonaccidental injury.     

Black Esophagus: Acute Esophageal Necrosis in Fatal Haloperidol Intoxication

Herein, we present a case of 53‐year‐old psychotic woman with acute esophageal necrosis (black esophagus), who was found lying on the floor in the living room of her flat. Pillboxes of antipsychotic drugs were located in the bin. External examination of the body was unremarkable. On internal examination, we found acute esophageal necrosis. Histologically, there was complete epithelial necrosis with focal involvement of muscularis mucosae, dense infiltrate of leukocytes, and ulcerations without any viable cells. There was no evidence of underlying organic diseases or trauma. Toxicological analysis revealed a fatal blood level of antipsychotics (haloperidol, zotepine, and chlorprothixene). Death of the deceased was attributed to fatal intoxication with three various types of antipsychotics. As far we know, this is the first described association between so‐called black esophagus and fatal blood level of neuroleptics.     

喉气管支气管炎猝死法医学检验文献回顾

喉气管支气管炎是一种罕见的上呼吸道感染,病变主要涉及上呼吸道声门下至支气管部位,发病多见于学龄前儿童。患者常见的,瞄床表现为喘呜,犬吠样咳嗽甚至呼吸窘迫。严重的喉气管支气管炎可导致急性呼吸道阻塞引起呼吸功能衰竭死亡。喉气管支气管炎所导致猝死在法医学实践中较为罕见。本文回顾了喉气管支气管炎相关的文献报道并结合2例典型喉气管支气管炎急性发作导致猝死的案例进行综述,主要探讨喉气管支气管炎患者临床表现、尸体检验以及法医病理学检查特征。     

Spaced cognitive interviewing: Facilitating therapeutic and forensic narration of traumatic memories

Abstract

The evolution of the cognitive interview (CI) is reviewed from the original package of memory-enhancing techniques through to the revised (or enhanced) CI, and the cognitive approach now taught to police officers in UK. Many officers are reluctant to apply CI, particularly to traumatised victims. The traumatising effects of crime are examined in terms of immediate response and the potential for an acute stress response and post-traumatic stress disorder, with subsequent re-experiencing of dissociated traumatic memories in the form of intrusive, unwanted imagery. Traumatic memories are described, particularly their accuracy, detail and persistence. The therapeutic potential of prolonged experience of distress while narrating the content of traumatic imagery is explained. An approach to maximising the disclosure of dissociated detail - spaced cognitive interviewing (SCI) - is described and case material presented illustrating its forensic and therapeutic application. The practice and practical implications of SCI are summarised.     

Laryngeal Choking on Food and Acute Ethanol Intoxication in Adults—An Autopsy Study*

Abstract: The retrospective autopsy study included 98 adults who died because of laryngeal choking on a bolus of food: 67 men and 31 women (χ² = 6.843, p < 0.01), average age 58.61 ± 15.87 years (range 26–92 years). Most of the subjects had poor dentition (χ² = 34.327, p < 0.01). Twenty individuals died in medical institutions, and 78 were nonhospitalized individuals. More than a third of the nonhospitalized individuals were under the influence of ethanol at the moment of death: average blood concentration 8.3 g/dL (SD = 11.0), ranged from 5.0 to 36.0. Nonhospitalized persons were at the moment of event more often under influence of ethanol than the subjects in control group (χ² = 38.874, p < 0.01), and at the same time significantly more intoxicated (z = −7.126, p < 0.01). Our study pointed out that poor dentition and impairment of the swallowing reflex, as a consequence of ethanol intoxication in individuals without mental disorders, were the most important risk factors for bolus death.